A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma

Abstract

Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures. We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis. The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM. A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0-2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.

Fig. 1

Distribution of the number of infectious events per month from treatment.

Fig. 2

Cumulative incidence of severe infections comparing non-candidate transplant patients.

Fig. 3. Cumulative incidence.

A Cumulative incidence of severe infection and B mortality by infection.

Fig. 4. Impact on overall survival of infection.

A Impact on overall survival of any-grade infection and B severe infection.

Fig. 5. Cumulative incidence of early severe infection according to risk group by Score GEM.

A Three risk groups with different probabilities of early severe infection. B Two risk group when intermediate and high risk were grouped. sHR sub-Hazard ratio, CI 95% confidence interval.